Original Article Association of gestational diabetes mellitus with preeclampsia: a retrospective cohort study
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Int J Clin Exp Med 2021;14(1):573-580 www.ijcem.com /ISSN:1940-5901/IJCEM0120902 Original Article Association of gestational diabetes mellitus with preeclampsia: a retrospective cohort study Shuyan Qu1*, Liyuan Dong2* Departments of 1Endocrinology, 2Gynaecology and Obstetrics, Daqing Oilfield General Hospital, Daqing, Heilongjiang Province, China. *Equal contributors and co-first authors. Received August 23, 2020; Accepted October 19, 2020; Epub January 15, 2021; Published January 30, 2021 Abstract: Objective: To explore the impact of gestational diabetes mellitus (GDM) on preeclampsia. Methods: Singleton pregnant women who registered in our hospital between January 2010 and January 2020 were enrolled in this retrospective cohort study. GDM is diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Groups Consensus. Univariate and multivariate logistic regression analyses were conducted to estimate the relative risk between GDM and preeclampsia. Results: Among the 800 singleton preg- nancy women analyzed, 66 (8.25%) was diagnosed with GDM. We found that women with GDM had a higher risk of developing preeclampsia than women with non-GDM (12.12% vs. 4.09%, P
Association of gestational dabetes mellitus with preeclampsia
Figure 1. Study flowchart.
Pregnancy Study Groups Consensus [12]. obtain approval from an ethics committee of a
Briefly, GDM received a 75 g oral glucose toler- Daqing Oilfield General Hospital. The study
ance test (OGTT) between 24 and 28 weeks received no special funding from funding agen-
gestation and they had fasting blood glucose cies in the public, commercial or non-profit
≥5.1 mmol/L (92 mg/dL), 1-hour plasma glu- sectors.
cose ≥10.0 mmol/L (180 mg/dL) and 2-hour
plasma glucose ≥8.5 mmol/L (153 mg/dL). Statistical analysis was performed using Stata
13.0 software (Stata Corp, USA). Continuous
Preeclampsia was diagnosed at 20 to 39 weeks variables were compared using student T-test
of gestation and confirmed as preeclampsia if or Mann-Whitney U test. The Chi-square test
the pregnant women had systolic or diastolic and Fisher’s exact test were used to compare
blood pressure of >140/90 mmHg and 24 h uri- categorical variables. Associations between
nary albuminuria >300 mg [13]. GDM and the risk of preeclampsia were tested
Inclusion criteria: Singleton pregnant women by univariate analysis and multivariate logistic
who successfully live delivery in a hospital. regression analysis. The dependent variable
Exclusion criteria: pregnant women with type 1 that we studied was preeclampsia. Results of
or type 2 diabetes mellitus diagnosed before logistic regression were expressed as adjusted
pregnancy; pregnant women with hypertension OR with the 95% confidence interval (CI), and
or cardiovascular disease diagnosed before potential confounders include age, pregnancy
pregnancy; pregnant women with a history of a BMI, education level, folic acid supplement,
serious systemic disease, such as cirrhosis, dyslipidemia, family history of hypertension
severe anemia, chronic renal failure or immune and polycystic ovary syndrome. PAssociation of gestational dabetes mellitus with preeclampsia
Table 1. Demographics and pregnancy characteristics data
No. of pregnant No preeclampsia Preeclampsia
P value
women (n = 800) (n = 762, [95.25%]) (n = 38, [4.75%])
Age 800 30.62±4.94 31.24±4.17 0.451
Pregnancy BMI (kg/m2) 800 20.99±2.84 23.31±2.10 0.000
Pregnancy BMI (kg/m2) 0.002Association of gestational dabetes mellitus with preeclampsia Table 2. Assignment of related factors Relevant factor Variable assignment Age Continuous variables Pregnancy BMI (kg/m2)
Association of gestational dabetes mellitus with preeclampsia
Table 4. Multivariate risk analyses for preeclampsia
Preeclampsia Multivariate analysis
(n = 38, [4.75%]) Adjusted OR (95% CI) P Value
Age 38 1.04 (0.96-1.11) 0.352
Pregnancy BMI (kg/m2) 0.007Association of gestational dabetes mellitus with preeclampsia
ed with preeclampsia (1.26 [1.06-1.50]) [14]. established in this study has high predictive
At present, the reason for the higher risk of pre- value.
eclampsia in patients with gestational diabetes
is still unclear. Beysel et al. reported that the Through this retrospective cohort study, we
HNF1αp.I27L TT genotype was associated with explored the association between gestational
preeclampsia risk in patients with GDM [15]. A diabetes and preeclampsia, and adjusted the
study suggests that GDM combined with pre- influence of confounding factors on the out-
eclampsia may be involved in the endothelial come. But there are still some limitations in our
injury [16]. On the other hand, patients with research. Firstly, this study is a retrospective
GDM have a higher risk of preeclampsia, which cohort study, there may be bias in the process
might be related to insulin resistance [17]. of collecting patient data, which may affect the
accuracy of the results. Secondly, although our
Compared with pregnant women and with nor- study shows that gestational diabetes is asso-
mal blood lipid level, pregnant women with dys- ciated with preeclampsia, the sequential rela-
lipidemia were more likely to develop pre- tions between preeclampsia and GDM remains
eclampsia. Cao et al. found that pregnant wom- unclear. Thirdly, we don’t know whether patients
en’s dyslipidemia is related to GDM and pre- with GDM can effectively control their blood
eclampsia [16]. In a study done by Kandimalla, sugar, and we cannot compare the effect of
et al., 156 pregnant women were included prior blood sugar control on the results. Fourthly, we
to 20 weeks of gestation and their lipid levels adjusted the impact of some confounding fac-
were detected. They found that the mean TG tors on the results, but there may still be some
levels were found to be significantly higher in confounding factors missing.
the preeclampsia group, and women with TG
In summary, GDM, pre-pregnancy BMI ≥25 kg/
levels above 130 mg/dL had an increased risk
m2 and dyslipidemia are significantly associat-
of developing preeclampsia compared with
ed with preeclampsia. Pregnant women with
those with TG levels of 91 mg/dL or less [18]. A
GDM or who are obese before pregnancy or
retrospective analysis of 9911 pregnant women
dyslipidemia have a significantly increased risk
found that dyslipidemia was significantly asso- of developing preeclampsia. We suggest that
ciated with preeclampsia after adjustment for patients with GDM should be actively tested for
confounding factors [19]. preeclampsia, and it is recommended to reduce
weight and regulating dyslipidemia before preg-
Studies from different populations have consis-
nancy to reduce the risk of preeclampsia.
tently reported that elevated pre-pregnancy
BMI is associated with an increased risk of pre- Disclosure of conflict of interest
eclampsia [20-26]. Our study found that the
risk of preeclampsia in women with pre-preg- None.
nancy BMI ≥25 kg/m2 is 3.15 times than that of
those with pre-pregnancy BMIAssociation of gestational dabetes mellitus with preeclampsia
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